OBJECTIVE: To investigate whether a new anaesthesia protocol can reduce opioid use in obese patients following laparoscopic sleeve gastrectomy. METHODS: This prospective observational case series was conducted in a private hospital in Hong Kong that has been accredited as a Centre of Excellence for Bariatric Surgery. Thirty consecutive patients scheduled for laparoscopic sleeve gastrectomy from 1 January 2015 to 31 March 2015 were reviewed. RESULTS: Of the 30 patients, 14 (46...

PROBLEM: The availability of less expensive and smaller ultrasound machines has enabled the use of ultrasound in virtually all major medical/surgical disciplines. Some medical schools have incorporated point-of-care ultrasound training into their undergraduate curriculum, whereas many postgraduate programs have made ultrasound training a standard. The Chinese University of Hong Kong has charged its Department of Anaesthesia and Intensive Care to spearhead the introduction of ultrasound into the final-year medical curriculum by introducing handheld transthoracic echocardiography as part of perioperative assessment...

BACKGROUND: Nitrous oxide is commonly used in general anaesthesia but concerns exist that it might increase perioperative cardiovascular risk. We aimed to gather evidence to establish whether nitrous oxide affects perioperative cardiovascular risk. METHODS: We did an international, randomised, assessor-blinded trial in patients aged at least 45 years with known or suspected coronary artery disease having major non-cardiac surgery. Patients were randomly assigned via automated telephone service, stratified by site, to receive a general anaesthetic with or without nitrous oxide...

Two months ago, while researching in Hong Kong, I was sent an Australian newspaper reporting a visit to Sydney by Professor Simpson, professor of Anaesthesia at London Hospital. He was quoted as having said; "Acupuncture seemed to have an exciting potential in medical science. It is going to have a very great impact in the practice of anaesthesia" and later, "The apparent success of acupuncture may be explained on the grounds that the needles distracted the patient's attention from the main course of pain".

The primary objective of this survey was to investigate the prevalence of insomnia among anaesthetists in Hong Kong. The use of sleeping aids, factors associated with insomnia and the effect of insomnia on work performance were also studied. We surveyed all locally registered anaesthesia specialists and trainees by post. The response rate was 50%. We found that the prevalence of insomnia among the respondents was 22.4% (95% confidence interval 16.7 to 28.1%). Insomnia was positively associated with the number of on-call shifts per month (P=0...

e-Learning has revolutionized the way in which undergraduate medical education is delivered. One e-learning tool of note is the virtual patient (VP), a type of computer software that simulates real-life clinical scenarios, in which the learner emulates the role of health care provider to obtain the history, conduct examination, and make diagnoses and management decisions. VPs have been in use since 1993. Early designs were based on serial screen-cards of patient history, examination, investigations, diagnoses, treatment, and outcome, which the learner explored...

OBJECTIVE. To review our experience in virtual blood banking for intra-operative transfusion in Hong Kong. DESIGN. Retrospective study. SETTING. Three major acute hospitals and a specialised centre for joint replacement surgery with installation of an Operating Theatre Blood Transaction System. PATIENTS. Patients undergoing surgery under anaesthesia and requiring intra-operative transfusion for the period from the implementation of the system in individual institutes (Queen Elizabeth Hospital: June 1997; Princess Margaret Hospital: May 2001; Queen Mary Hospital: October 2009; and Hong Kong Buddhist Hospital: December 2010) till September 2011...

OBJECTIVES: The use of ultrasound to guide peripheral nerve blocks is now a well-established technique in regional anaesthesia. However, despite reports of ultrasound guided epidural access via the paramedian approach, there are limited data on the use of ultrasound for central neuraxial blocks, which may be due to a poor understanding of spinal sonoanatomy. The aim of this study was to define the sonoanatomy of the lumbar spine relevant for central neuraxial blocks via the paramedian approach...

Nitrous oxide is an antagonist at the N-methyl-D-aspartate receptor and may prevent the development of chronic postsurgical pain. We conducted a follow-up study in the Evaluation of Nitrous Oxide in the Gas Mixture for Anaesthesia (ENIGMA) trial patients to evaluate the preventive analgesic efficacy of nitrous oxide after major surgery. The ENIGMA trial was a randomized controlled trial of nitrous oxide-based or nitrous oxide-free general anesthesia in patients presenting for noncardiac surgery lasting more than 2 hours...

OBJECTIVE: To review the outcomes of endoscopic carpal tunnel release in a Hong Kong public hospital and identify any predictive factors. DESIGN: Retrospective study. SETTING: Regional hospital with a hand surgery service, Hong Kong. PATIENTS: Between January 2001 and December 2007, records of 145 patients (160 carpal tunnel syndromes) having endoscopic release were reviewed. Five major symptom domains (pain, numbness, nocturnal awakening, weakness, and clumsiness) before and after the operation were scrutinised...

OBJECTIVES: To test the hypothesis that blood transfusion alone was a significant risk factor for in-hospital morbidity in non-cardiac patients. DESIGN: Propensity analysis. SETTING: University teaching hospital, Hong Kong. PATIENTS: Consecutive non-cardiac patients seen in our department from 2006 to early 2009 who underwent a major procedure under general or spinal anaesthesia were included. Propensity analysis was performed to neutralise the confounding effects of preoperative variables and identify the true effects of transfusions on surgical outcomes...

OBJECTIVE: To review the efficacy of telephone preoperative anaesthesia assessment in patients undergoing ambulatory breast surgery. DESIGN: Retrospective study. SETTING: Day Surgery Centre, Tung Wah Hospital, Hong Kong. PATIENTS: Patients with breast lumps to be excised were seen by dedicated breast surgeons and informed of day procedures and preoperative anaesthesia assessment. Those who fulfilled the selection criteria of age (18-45 years) and American Society of Anesthesiologists grade I were recruited for telephone anaesthesia assessment preoperatively...

OBJECTIVE: To examine the safety and efficacy of endovenous laser obliteration to treat varicose vein in a day surgery setting, using sedation and local anaesthesia. DESIGN: Prospective study. SETTING: Day surgery centre in a regional hospital in Hong Kong. PATIENTS: A total of 24 patients with duplex-confirmed long saphenous vein insufficiency underwent endovenous laser (940 nm) varicose vein treatment from July to November 2007 in a single day surgery centre...

The Effective Management of Anesthetic Crises (EMAC) course is a joint initiative between the Australian and New Zealand College of Anesthetists (ANZCA) and simulation centers. This standardized 2.5-day course has become an integral component of training for Fellowship of ANZCA and as such is an innovative development on the global anesthesia scene.Since its inception in 2002, over 600 anesthetists, with equal numbers of specialists and trainees, have attended EMAC throughout Australia, New Zealand, and Hong Kong...

OBJECTIVE: To study clinical perspectives pertaining to chronic sclerosing sialadenitis, which is also known as Kuttner's tumour. DESIGN: Retrospective medical chart review. SETTING: Regional hospital, Hong Kong. PATIENTS: From February 2005 to February 2007, nine cases with Kuttner's tumour were identified from our hospital electronic database. INTERVENTIONS: They underwent submandibular sialadenectomy under either local (n=6) or general (n=3) anaesthesia...

AIMS: This study aimed to compare the effectiveness of two preoperative nursing interventions and examining the appropriateness of using the Children's Emotional Manifestation Scale in evaluating the effectiveness of preoperative interventions. BACKGROUND: There is some evidence that the Children's Emotional Manifestation Scale can be used as an objective assessment tool in documenting children's emotional responses. However, it is uncertain from previous study that whether the scale can be used in evaluating the effectiveness of preoperative interventions...

OBJECTIVE: To compare postoperative outcomes in patients having primary total knee arthroplasty receiving general or regional anaesthesia. DESIGN: Randomised prospective study. SETTING: Regional hospital, Hong Kong. PATIENTS: Patients having primary total knee replacement were randomised to either general anaesthesia followed by postoperative intravenous patient-controlled analgesia with morphine, or combined spinal-epidural anaesthesia followed by postoperative epidural infusion of bupivacaine 0...